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Radiation Therapy

Radiation Therapy. Patharakrit Teewasutrakul (DVM ) Oncology Clinics SMALL ANIMAL Hospital Chulalongkorn University. Introduction to Radiation Therapy. History 1895 Wilhelm Conrad Röntgen -Diagnosis &Therapeutic purposes 1902 Radiation induced cancer was reported

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Radiation Therapy

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  1. Radiation Therapy PatharakritTeewasutrakul(DVM) Oncology Clinics SMALL ANIMAL Hospital Chulalongkorn University

  2. Introduction to Radiation Therapy History 1895 Wilhelm Conrad Röntgen -Diagnosis &Therapeutic purposes 1902 Radiation induced cancer was reported 1903 suggestion to treat cancer w implanting radium 1930 Initial clinical use of radiation dose fractionation 1972 Computed Tomography and Radiation therapy 1990 3D setting w tumor hypoxia and the tumor environment 1994 Am College of Veterinary Radiology 2009 -Currently about 70 board-certified veterinary radiation oncologists -Residency programs in USA -Veterinary Technicians (Barbara Kaser- Hotz. ,36thWSAVA 2011) (Elizabeth McNiel.,29th Annual conference of the VCS 2009)

  3. What is the Radiation Therapy รังสีที่ใช้รักษาได้แก่ รังสีเอกซ์ รังสีแกมมา นิวตรอน และพวกอนุภาคต่างๆ ส่วนใหญ่แล้วมักนิยม ใช้รังสีแกมมาจากเครื่องโคบอลต์-60 รังสีเอกซ์พลังงานสูง จากเครื่องเร่งอนุภาค และนิยมใช้อนุภาคอิเล็กตรอน รักษาบริเวณพื้นผิวตื้น ๆ การเลือกชนิดและพลังงาน ของรังสีรักษา ต้องพิจารณาลักษณะรูปร่าง ตลอดจนตำแหน่งที่ตั้งของก้อนมะเร็ง

  4. Types of radiation • 1. Electromagnetic Radiation  • 1.1รังสีเอกซ์ (x-rays) source : high energy x-ray equipments • 1.2รังสีแกมมา (gamma-rays) :radioactive isotopes nucleus • 2.  Particle Radiation:Linear Accelerator • 2.1  อนุภาคอิเล็กตรอน (Electrons) • 2.2  อนุภาคอื่น ๆ เช่น โปรตรอน(Photons)

  5. How does radiation kill cells?

  6. Radiation therapy and Biological response of tumor and normal tissue Relative radiosensitivity of common animal tumours Relative radiosensitivity of normal animal tissue

  7. How radiation dose is measured? The Absorbed dose :Gray(Gy)= SI unit 1Gray(Gy)=1joule(j) of energy absorbed by 1 kg tissue 1Gray(Gy)=100 Rad 1Rad =100ergs/g 1 Fraction =Individual radiation treatment dose Total dose= Fraction X Time of RT treatment.

  8. Principles of Radiation Oncology The concept of therapeutic ratio for radiation therapy

  9. Principles of Radiation Oncology The concept of therapeutic ratio for radiation therapy Ideal X O Radiosensitive tumor Radioresistant tumor Limited sensitive tumor

  10. Fractionation Details Treatment procedure 1.Total dose (Gy) 2.Fraction size (Gy) 3.Duration of Tx.

  11. Fractionation effect Exponential tumor cell killing by radiation

  12. Fraction ation and Tumor biology 4R’s radiobiology 1.Repair 2.Repopulation 3.Redistribution 4.Reoxygenation

  13. Radiation therapy Types of Radiation Therapy 1. Teletherapy orExternal beam therapy 2.Plesiotherapy orBrachytherapy 3. Unsealed source therapy or Nuclear medicine

  14. 1.Teletherapy orExternal beam therapy Model Linac Linear Accelerator (4-20MeV)

  15. Different types of animal immobilization Stand Mask

  16. Different type of animal immobilization Tooth block Cat and tooth block

  17. Different type of animal immobilization Position of dog during RT Dog and tooth block

  18. Different types of animal immobilization Vacuum bag Animal immobilization

  19. Radiotherapy treatment planning 1.Measures of tumor volume CT scan • Equipment • CT or MRI • X-rays

  20. Radiotherapy treatment planning CT &MRI CT&MRI

  21. Radiotherapy treatment planning Hand &Computer planning

  22. Radiotherapy treatment planning 3D Virtual Simulation Computer planning

  23. Radiotherapy treatment planning 3D Virtual simulation Computer planning

  24. Radiation therapy:Beam control Multileaf collimator Other devices

  25. Virtual Simulation : multiple fields RT

  26. Radiotherapy treatment planning

  27. Monitoring RT procedure

  28. Radiation Therapy Dog and oronasal mass: canine oral melanoma multiple fields RT

  29. Radiation therapy Cat : CT scan for RT preparation Cat with nasal lymphoma

  30. Common tumours amenable to radiation therapy

  31. 2.Plesiotherapy orBrachytherapy Iridium-192 Strontium-90

  32. 3. Unsealed source therapy or Nuclear medicine Iodine-131

  33. Common radiation therapy side effects Acute side effects Delay side effects

  34. Common radiation therapy side effects

  35. Common radiation therapy side effects Acute moist desquamation Delay effect :Depigmentation

  36. Radiation Therapy in Veterinary Medicine 1.Radiation therapy alone • Curative Treatment • Local and small tumor size • Almost radiosensitive tumor types • Palliative Treatment • Reduce cancer pain • Destroy cutaneous metastasis tumor • Slowly tumor growth rate

  37. Combined Radiation with Other modalities 1. Combined Radiationand Surgery 2.Combined Radiation and Systemic therapy Preoperative irradiation Intraoperative irradiation Postoperative irradiation • Chemotherapy: • Synergistically improve • Doxorubicin • Carboplatin • Gemcitabine • Paclitaxel are all shown to improve the effects of radiation • Adjuvant chemotherapy • Neoadjuvant Chemotherapy • Immunotherapy • Melanoma vaccine

  38. Radiation Therapy in Veterinary Medicine Weak point

  39. Future Direction of Radiation Therapy IMRT : Intensity modulated RT Rapid Arc : 4D RT

  40. Radiation Therapy in Veterinary Medicine Clinical application

  41. Radiation Therapy Dog and oronasal mass: canine oral melanoma multiple fields RT

  42. Radiation therapy Cat : CT scan for RT preparation Cat with nasal lymphoma

  43. Use of strontium-90 plesiotherapy for the treatment of a lingual plasmacytoma in a dog. K. Ware and T. Giegeretal. Journal of Small Animal Practice (2011) 52, 220–223 1.Plasmacytoma 4.RT 150Gy 3.Therapeutic Planing 2.cytology 5.Post RT

  44. Prognostic significance of specific magnetic resonance imaging features in canine nasal tumours treated by radiotherapy . P. AGTHE*, A. R. CAINE, R. N. A. GEAR et al., Journal of Small Animal Practice (2009) 50, 641–648

  45. Prognostic significance of specific magnetic resonance imaging features in canine nasal tumours treated by radiotherapy . P. AGTHE*, A. R. CAINE, R. N. A. GEAR et al., Journal of Small Animal Practice (2009) 50, 641–648

  46. Prognostic significance of specific magnetic resonance imaging features in canine nasal tumours treated by radiotherapy . P. AGTHE*, A. R. CAINE, R. N. A. GEAR et al., Journal of Small Animal Practice (2009) 50, 641–648

  47. Intensity-Modulated and Image-Guided Radiation Therapy forTreatment of Genitourinary Carcinomas in DogsM.W. Nolan, L. Kogan, L.R. Griffin, et al. J Vet Intern Med 2012;26:987–995 UB target

  48. Intensity-Modulated and Image-Guided Radiation Therapy forTreatment of Genitourinary Carcinomas in DogsM.W. Nolan, L. Kogan, L.R. Griffin, et al. J Vet Intern Med 2012;26:987–995 Colon UB

  49. Intensity-Modulated and Image-Guided Radiation Therapy forTreatment of Genitourinary Carcinomas in DogsM.W. Nolan, L. Kogan, L.R. Griffin, et al. J Vet Intern Med 2012;26:987–995

  50. Questions

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